在杜洛特格拉维尔过渡期间的HIV-1病毒载量抑制和耐药性的模式:基于人口的纵向研究
Michael A Martin1,2, Alexandra Blenkinsop3,4, Michelle Moffa5
1Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
概括
乌干达的基于多卢特格拉维尔 (DTG) 的艾滋病毒治疗显著增加了艾滋病毒感染者的病毒抑制. 虽然对旧药物的耐药性下降了,但对像insS153Y这样的新耐药性突变的持续监测至关重要.
科学领域:
- 传染性疾病 传染性疾病
- 病毒学 病毒学
- 公共卫生 公共卫生
背景情况:
- 在撒哈拉以南非洲,基于多卢特格拉维尔 (DTG) 的抗逆转录病毒疗法 (ART) 对人口水平影响的数据有限.
- 这项研究评估了乌干达在DTG扩展期间十年的病毒抑制和ART耐药性趋势.
研究的目的:
- 评估基于DTG的ART疗法在实现病毒抑制方面的有效性.
- 监测大队伍中抗逆转录病毒耐药性的出现和流行情况.
- 了解DTG过渡对乌干达艾滋病毒治疗结果的影响.
主要方法:
- 利用了来自Rakai社区队列研究 (2011-2023) 的数据,涉及8,781名艾滋病毒感染者 (PLHIV).
- 雇员问卷,艾滋病毒检测,病毒载量定量和对抗性分析进行深度测序.
- 应用了强大的Poisson和贝叶斯逻辑回归来估计抑制,阻力及其关联.
主要成果:
- 在PLHIV中,病毒抑制率从2014年的57.1%增加到2022年的90.3%.
- 到2020年,DTG的使用率在男性中达到84.4%,在女性中达到64.6%.
- 在经过治疗的病毒性PLHIV中,中级/高级ART耐药性从2014年的51.1%下降到2022年的27.9%.
- 在2022年,两名参与者 (0.8%) 具有中等/高水平的DTG耐药性;在S153Y (INSTI耐药性) 中,7.5%的病毒性个体被发现.
结论:
- 在DTG过渡期间,病毒抑制显著改善,高度耐药性的出现最小.
- 经验丰富的PLHIV患者的抗药性降低凸显了ART坚持的重要性.
- 在S153Y的出现需要持续监测整合酶链转移抑制剂 (INSTI) 耐药性.
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